Microvascular Damage: Destruction of small blood vessels contributes to kidney damage, blindness, and various neuropathies. Microvascular injury is directly

related to the degree and duration of hyperglycemia.

***Of note, ACE inhibitors and ARBs have an additional benefit: they can help control hypertension, a common complication of diabetes.

***Treatment with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) can delay the onset of nephropathy, and can slow progression of nephropathy that is already present

*** ACE inhibitor (eg, captopril) or an ARB (eg, losartan) can help protect against diabetic nephropathy.

What Three tests diagnose diabetes?

a fasting plasma glucose (FPG) test,

a casual plasma glucose test,

and an oral glucose tolerance test (OGTT).

If diet and exercise fail for Type II diabetic pts, what are some other options?

Options include oral antidiabetic agents,

the new injectable hypoglycemic drugs—pramlintide and exenatide—

and, if needed, daily insulin

What are the target values for glucose before meals?
at bedtime?

90 to 130 mg/dL before meals

100 to 140 mg/dL at bedtime.

What is the principle stimulus for a rise in glucose

The principal stimulus for insulin release is a rise in blood glucose.

***however, Insulin release may also be triggered by amino acids, fatty acids, and ketone bodies.

What receptor promotes secretion of insulin

beta2-adrenergic receptors in the pancreas

What receptor inhibits secretion of insulin

alpha-adrenergic receptors in the pancreas

Is insulin primarily anabolic or catabolic?

The metabolic actions of insulin are primarily anabolic (ie, conservative or constructive). Insulin promotes conservation of energy and buildup of energy stores. The hormone also promotes cell growth and division.

The process of maintaining glucose levels within a normal range, around the clock

What are the benefits of tight glucose control?

decrease in clinically significant kidney disease

decrease in neuropathy

decrease in serious ophthalmic complications.

What are the drawbacks of tight glucose control?

hypoglycemia

What increases the need for insulin and possible dosage adjustment?

infection, stress, obesity, the adolescent growth spurt, and pregnancy after the first trimester.

What decreases the need for insulin and possible dosage adjustment?

exercise and during the first trimester of pregnancy.

What are the 6 main families of Oral Hypoglycemics?

biguanides,

sulfonylureas,

glinides (meglitinides),

thiazolidinediones (glitazones),

alpha-glucosidase inhibitors,

gliptins.

In what 2 ways do the oral agents work?

Some of them—notably the sulfonylureas, glitazones, and glinides—actively drive blood glucose down.

Others—notably metformin (a biguanide) and the alpha-glucosidase inhibitors—don't drive blood glucose down; rather, they simply modulate the rise in glucose that happens after a meal.

What is an example of a Biguanide?
How does it work?

Metformin;

lowers blood glucose and improves glucose tolerance in three ways. First, it inhibits glucose production in the liver. Second, it reduces (slightly) glucose absorption in the gut. And third, it sensitizes insulin receptors in target tissues

Metformin (Glucophage) is likely to....
a rare effect is

cause weight loss

lactic acidosis

What is an example of a Sulfonylurea?
How does it work?

Glyburide (DiaBeta)

Stimulates insulin release and reduces glucagon levels

**avoid during pregnancy

If you mix a Sulfonylurea and alcohol, what happens?
If you mix a Sulfonylurea and an NSAID, what happens?
If you mix a Sulfonylurea and a Beta Blocker, what happens?

nausea, vomiting, facial flushing, palpations

low blood sugar

diminishes effect of sulfonylurea

What is an example of a Meglinatide?
How does it work?

repliginide (prandin)

Stimulates insulin release

What are some adverse effects of Meglinatides?

Hypoglycemia

*patients eat no later than 30 minutes after taking the drug.

What is an example of a Thiazolidinedione?
How does it work?

rosiglitazone (Avandia)

turns on insulin-responsive genes that help regulate carbohydrate and lipid metabolism. As a result, cellular responses to insulin are increased

What are some adverse effects of a Thiazolidinedione?

fluid retention= edema

monitor liver function

Increase in LDL and TG

What is an example of a Alpha glucosidase Inhibitor?
How does it work?
Adverse effects?

acarbose (Precose).

Delays the digestion of carbohydrates, resulting in a smaller postprandial rise of blood glucose.